


After the storm

by phobic_nurz



Category: Hannibal (TV)
Genre: Gen, Medical, Mizumono Spoilers, Paramedic - Freeform, Post-Episode: s02e13 Mizumono, Post-Finale, first responder
Language: English
Status: Completed
Published: 2014-07-04
Updated: 2014-07-04
Packaged: 2018-02-07 10:27:47
Rating: Mature
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 1
Words: 2,359
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1895685
Author URL: https://archiveofourown.org/users/phobic_nurz/pseuds/phobic_nurz
Summary: <blockquote class="userstuff">
              <p>The scene at Hannibal's house of horror from the point of view of the first responder on site.</p>
            </blockquote>





	After the storm

The torrential rain is cold, even through my uniform, I'd been hoping this was a BS call because this isn't even my shift and I don't want to be dealing with gunshots in a pretty neighbourhood. I can tell before I shut the door to the rig that this is not a BS call. The front door stands open and the window above it is smashed, the void in what looks to be previously an ornate window is person-shaped. I slam the door and motion my partner to the end of the street as I catch sight of a dark shape on the floor in front of the door. Where are the police? The report of shots fired means they should be here first but they aren't. I shouldn't even approach until they are but I can't leave whoever that is in a pool of their own blood in the pouring rain. My pulse rate quickens as I approach, I've had the person play dead and then pull a weapon, but I can tell before I arrive at her side that this woman won't be doing that. 

"Hey there." I say lightly as if this is an everyday meeting for us both as I casually assess her. 

"Inside." She whispers. 

Good, she's breathing, score one for her. Bad she's whispering, she putting in an awful lot of effort to still be breathing, her lips are blue, her chest is heaving, her mouth wide. It's not panic, her body is using every trick it has to pull in oxygen because it's damaged, badly. 

"What's your name?" I ask, ignoring her instruction. She has my attention for now. 

"Alana."

I put an oxygen mask on her face with flow pushed as far as it can go, the hissing is loud but I ignore it and continue to give my patient a smile, just another day, nothing to worry about. I deftly slip my fingers to her neck and measure her pulse, it is racing but her circulation isn’t reaching the edges, she’s loosing blood somewhere and there wasn't enough on the ground to justify the profound signs of hypovolaemia I'm seeing. A quick visual check tells me she's got several broken ribs and from my perch by her head I can see her left leg is shortened and rotated, fractured pelvis, blood loss bingo. 

"Where's the pain Alana?"

"My head."

Not chest, not pelvic, both painful injuries that she's not feeling. Spinal collar is a must. It's slipped under her seamlessly though it comes up blood stained from the back of her head, maybe a scull fracture too. 

"Is who did this in the house?"

"Maybe."

"Is anyone else in the house?"

"Jack, Will, Abigail."

She's gasping now, no more answers for now, my gloves finger reaches up to the radio on my lapel, "Get the police here and three more rigs there are more casualties inside."

I turn my attention back to the patient in front of me, if she were more stable I would investigate the house and triage but she's not. 

"Alana? I have to do something with your leg to get it in line, it's going to hurt but I have to." A sharp pull and twist have a satisfying crunch. Alana didn't flinch. 

"You're a tough lady." I told her as I fasten a pelvic stabiliser around her hoping to stem the internal bleeding until I can get her to a surgeon who can stop it. She knows my comment is not true, I would've liked her to scream and cry, not because I wanted to cause her pain but because I wanted to know she could feel it. She clearly could not and remains unnaturally still as we are both on the ground in the torrential rain. 

Finally I see my partner approaching, I know he catches my expression. 

"Should I check inside?" 

"Wait for the police, her assailant could be inside still, she says there could be three more casualties in there. Get me a spinal board? I'm going to get access and start fluids."

How the hell I think I'm going to get a line into her I have no idea, she is cold as ice and as shut down as I’ve ever seen, but it's what she needs so I have to try. Never mind the pitch dark and pouring rain, they are just a secondary consideration to fact I know this woman's veins have all but closed up to keep blood pumping to her brain as her supply leaks into her abdomen and onto the ground around us. I'm fumbling a little as I grab a torch and turn it on, I can do lots of things by touch but this isn't one of them, I grip the torch with my teeth and direct the light to Alana's arm, there's rain waiter hitting the needle I'm about to place in her arm already and I worry about infection and haemolysis but I have to do it anyway. I'm relieved when I get a flash back first time and insecure the line as best I can. Adhesive dressings don't really like the rain. 

"OK Alana, I'm going to start some fluids and give you some pain relief, how's that head doing?"

This time there's no answer, she struggling to keep her eyes open, they're fluttering shut against her will, her blood pressure is dangerously low, or she's concussed from her blow to the head. There's no way to tell which. Despite the need to get the fluid into her system I administer it cautiously, I'm aware I don't want her blood pressure to get too high, it will blow any clots she has formed and make the situation worse, plus she has a head injury any blood pressure changes need to be slow.

My partner is back and the police arrive at the same time, the police don't glance at me but they do stop to regard my patient.

"Any idea how many inside?"

"She said three when I arrived." I tell them to spare her the effort. She looks grateful. 

Weapons drawn the two officers step into the house through the open door, I turn my attention back to the woman in front of me, "We're going to get you on this board to take you to hospital ok?"

She doesn't respond, her eyes are fixed on the figures entering the house. I wonder who she is and what went on here to end this way. Once she's on the board we tape her down to prevent any further movement, though it's plainly obvious to my partner and I that she isn't moving her limbs at all. I place a gauze pad on a bloody cut at her forehead while I'm waiting for my partner to bring the gurney from the ambulance, two other crews pull up and barrel into the house on the shouted instructions of the police team who declare the scene secure and guide them to more casualties. The gauze pad seems a little pointless as I survey her extremities, I'm supposed to log every injury but I'm don't think I can do that. She has abrasions and glass cuts too numerous to catalogue, I settle for deciding I will shade areas for clusters of cuts and specify those with visible debris in them. I wonder what state those inside are in. I can't imagine they can be worse off. But then why has no one come outside once. 

As we roll toward the rig I keep my eyes on the monitor that gives me a constant read out of Alana's vital signs. As we bring our heads together to close the doors I tell my partner quietly, "Put your foot down, and tell them to have a full trauma team ready, respiratory, neuro, everyone." I'm not confident how long I can keep her functioning at this level before her heart stops, her blood isn't running through her veins as it should. It's filing up her abdomen, and it's staining every surface in the ambulance. The rain has soaked us all, Alana is freezing cold, but that's in her favour a cold body and brain need less oxygen which is good she doesn't have it to spare. The cold causes vasoconstriction which will keep her blood pressure up a little, as she warms up that reflex will leave her with plummeting blood pressure. Her clothes are stuck to her and stained with blood, the rain water is running out of her hair stained pink spreading a coloured puddle across the floor and into the equipment that was bright white a moment ago. I'm covered too I realise as I leave a bloody handprint while silencing the monitor's alarms. Her oxygen levels are low and I can't make them rise, I bang the window between the driver and myself "Move it!" I yell. I'm sure it doesn't comfort her but she doesn't show it. 

"Is there anyone I can call for you? When we get to the hospital?" I ask, leaving out that I'm asking now because I don't think I'll be able to keep her conscious for much longer, her blood pressure is falling again. 

"Will...he's...was inside." She gasps, her oxygen levels take another dive. Giving up on the flimsy mask I reach for the ambu bag and hook it up high flow oxygen. Removing the plastic mask I throw it on the floor and replace it with the thicker sealing mask of the ambu bag as the reservoir fills up. She looks panicked momentarily, I forgot to tell her what I'm doing. 

"This is a better mask, I can give you some help with it." Meaning I can take over your breathing when you stop. Her heart rate continues to soar, now hitting 180 beats a minute, she's still bleeding despite the pelvic stabilisation. Abruptly her gasping stops and her face goes slack beneath the mask I have pressed to it. 

"Respiratory arrest!" I shout, and feel the vehicle surge a little, there isn't a lot more speed to be had from this wardrobe on wheels really. 

I start using the mask for its purpose and squeeze to pump air into her lungs, if I can do it adequately enough I can hopefully stop her going into circulatory arrest before we get to the hospital anyway. I'm not sure anything can stop that ultimately happening right now. She needs blood, clotting factors, surgery, intensive care. All I can do right now is cross my fingers and squeeze. Only one side of her chest rises with my ventilations, a fractured rib has punctured her lung and she has a pneumothorax, I'm not going to be able to get enough oxygen into her, she's maybe thirty-seconds from full traumatic arrest. Relief floods over me as my partner brings us to a halt, within seconds he's throwing the back doors open for us to unload her. The ER staff are waiting by the doors, some cross to us while others wait, presumably for the next patient to arrive. 

I start handing over as we head into the department and continue to pump air into her lungs, "This is Alana, she's in her thirties and has had a fall from a first floor window onto concrete. Top to toe, occipital laceration and possibly a skull fracture, multiple bilateral rib fractures and left sided pneumothorax leading to respiratory arrest, probable pelvic fracture, left leg initially shortened and rotated, repositioned and pelvic brace in-situ to attempt to control blood loss. Various, multiple lacerations and abrasions from the glass of the window, glass fragments evident in places." We're at the resuscitation bay and they switch over to their own monitors, all of which give the same ominous readings that mine did. I continue, "Initially alert and responsive, oriented to situation, no spontaneous movement noted in limbs, no complaints of pain other than due to head injury. Oxygenation deteriorated en-route due to developing pneumothorax, went into respiratory arrest approximately three minutes ago. Blood pressure sixty systolic, pulse rate one twenty to one eighty, very haemodynamically unstable." 

I'm out of breath but I give them every last detail anyway and I keep my position inflating her lungs, I can see a doctor lining up to put a tube in her airway, I'll soon be obsolete in this scenario, "You got a wide bore in the right anticutical fossa, I couldn't get a second line."

The information goes unacknowledged but I can already see it being acted upon. A surgical resident is preparing to insert a chest drain to re inflate her lung and I stand to the side to allow access for ET tube insertion, her heart rate is drifting down but I think we might be in time. Once the tube is in place I step back from the swarm of professionals and observe the scene with some level of pride in the way emergency medicine works these days. A doctor has finished inserting a chest drain, air and blood drain away from her lung and I can see they're able to inflate both sides of her chest and her oxygen levels rise accordingly. While this is going on a nurse is giving a rapid blood transfusion alongside blood clotting agents to stop the internal bleeding, sedation and pain relief are being administered and a portable X-ray machine is brought in for a rough look before she's stable enough for a top to toe CT scan. 

"Did they bring the others in behind us?" I ask a passing nurse. 

"Second was DOA, third hasn't arrived yet, fourth is still on scene they're having trouble extracting."

"We're they shot?"

"Stabbed looks like, real blood bath."

"The report was of shots fired." I say confused. 

"Maybe they missed." She replies as she leaves me to head back to the patient that was mine a moment ago and is her charge now. I watch as she enveloped in the swarm of activity and I wonder what happened. I resign myself to knowing that I probably won’t find out until I see her name in a newspaper.


End file.
